Chapter 5: Pancreas (Penny)

head, neck, body, tail

Four parts of the pancreas

uncinate process

Some people have an extension of the posteriomedial head known as __________ ____________

true pancreatic cyst

associated with von Hippel-Lindau disease and autosomal DOMINANT polycystic kidney disease.

insulin

beta cells produce

courvoisier GB

clinical detection of an enlarged, palpable GB caused by a biliary obstruction in the area of the head of the pancreas

zolliner-ellison syndrome

clinical findings of islet cell tumors - gastrinoma

low blood sugar symtptoms

clinical findings of islet cell tumors - insulinoma

the main pancreatic duct, the duct of wirsung, travels

length of the pancreas

Chyme

partially digested food

phlegmon

peripancreatic fluid collection that results from the inflammation of the pancreas

choledocholithiasis

presence of a gallstone or gallstones in biliary tree

islets of langerhans

small islands of tissue found within the pancreas that produce hormones (insulin and glucagon)

cystic mass that may appear solid and echogenic secondary to the small size of the cyst.

sonographic appearance of serous cystadenoma

CBD

the inferior (posterior) fish eye is the

pancreatic tail

the splenic vein marks the posterior border of this part of the pancreas?

GDA

the superior (anterior) fish eye is the

Whipple procedure

the surgical procedure on patients with pancreatic adenocarcinoma that removes the head of the pancreas, gallbladder and some of the bile ducts and proximal duodenum; aka pancreaticoduodenectomy

1-2cm

the tail should measure

true

true or false. islet cell tumors can be malignant or benign.

Von hippel-linau disease

what is associated with development of cysts within the pancreas?

exocrine process

1. enzymes drain from pancreas into duct of wirsung 2. into ampulla of vater where the enzymes mix with bile from liver and are released into the duodenum through sphincter of oddi 3. this liquid is mixed with chyme in the duodenum to breakdown food components

c. zollinger-ellison syndrome

A gastronome of the pancreas can produce: a. autosomal recessive PCKD b. von hippel-lindau disease c. zollinger-ellison syndrome d. hyperinsulinemia

Zollinger-Ellison syndrome

A syndrome that includes an excessive secretion of acid by the stomach caused by a functional GASTRINOMA within the pancreas.

c. weight gain

All of the following are classic clinical features of acute pancreatitis except: a. leukocytosis b. back pain c. weight gain d. fever

1. elevated amylase (within 24 hours) 2. elevated lipase (within 72 hours) 3. abdominal pain 4. back pain 5. fever 6. nausea / vomiting 7. leukocytosis 8. severe acute pancreatitis can lead to hemorrhaging and decreased hematocrit

Clinical findings of acute pancreatitis:

1. asymptomatic 2. persistent epigastric pain 3. jaundice 4. back pain 5. possible elevation in amylase or lipase

Clinical findings of chronic pancreatitis:

1. elevated amylase and/or lipase 2. loss of appetite 3. weight loss 4. jaundice 5. courvoisier GB 6. epigastric pain 7. loss of

Clinical findings of pancreatic adenocarcinoma

c. adenocarcinoma in the head of the pancreas

Courvoisier gallbladder is found in the presence of: a. hepatitis b. cholecystitis and chronic pancreatitis c. adenocarcinoma in the head of the pancreas d. islet cell tumor in the tail of the pancreas

ampulla of vater

Merging point of the pancreatic duct and CBD just before the sphincter of oddi; aka hepatopancreatic ampulla

d. lesser sac

One of the most common locations for a pancreatic pseudocyst in within the: a. paracolic gutters b. groin c. spleen d. lesser sac

exocrine gland that aids in digestion

Primary function of the pancreas?

alpha cells

Promotes the release of glucose by the liver (increases blood sugar levels)

1. heterogeneous, atrophic gland with poor margins 2. calcifications within the gland 3. pancreatic pseudocyst 4. dilated pancreatic duct 5. stones within the pancreatic duct that may lead to biliary obstruction 6. possible portosplenic vein thrombosis

Sonographic findings of chronic pancreatitis:

a. head

The most common location of adenocarcinoma of the pancreas is within the: a. head b. neck c. body d. tail

a. head

The most common location of focal pancreatitis is within the: a. head b. neck c. body d. tail

b. sphincter of Oddi

The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the: a. sphincter of vater b. sphincter of Oddi c. ampulla of vater d. ampulla of oddi

endocrine and exocrine

The pancreas functions as an __________ and ___________ gland

1. drink a cup of water 2. turn the patient LLD

What can help visualize the pancreas?

trypsin, chymotrypsin, and carboxypolypeptidase

What other enzymes does it secrete?

amylase, lipase, and sodium bicarbonate

What vital digestive enzymes does it secrete?

b. lipase

Which lab value listed below appears to be more specific for acute pancreatitis? a. amylase b. lipase c. AST d. SGOT

b. von hippel-lindau disease

Which of the following is associated with development of cysts within the pancreas? a. autosomal recessive polycystic kidney disease b. von hippel-lindau disease c. zollinger-ellison syndrome d. endoscopic retrograde cholangiopancreatography

c. insulinoma

Which of the following is the most common islet cell tumor? a. granuloma b. gastrinoma c. insulinoma d. cystadenoma

b. production of glucagon

all of the following are part of the exocrine function of the pancreas except for: a. production of lipase b. production of glucagon c. production of amylase d. production of sodium bicarbonate

d. diffusely hypoechoic pancreas

all of the following are sonographic features of chronic pancreatitis except: a. dilated pancreatic duct b. calcification within the pancreas c. pancreatic pseudocyst d. diffusely hypoechoic pancreas

glucagon

alpha cells produce

Pancreatic cystadenomas or cystadenocarcinoma

can be serous, which is small and always benign, or mucinous, larger and have malignant potential. Most often found in the body or tail.

1. choledocholithiasis 2. post endoscopic retrograde cholangiopancreatography (ERCP) 3. trauma

cause of acute pancreatitis

pancreatic pseudocyst

cyst surrounded by fibrous tissue that consists of pancreatic enzyme that have leaked from the pancreas

somatostatin

delta cells produce

hyperamylasemia

elevated amylase

islet cell tumors

endocrine tumors found within the isles of Langerhans

endoscopic retrograde cholangiopancreatography

endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas

duodenum

first segment of small intestine

acute pancreatitis

inflammation of the pancreas secondary to the leaking of pancreatic enzymes from acini cells into the parenchyma

autosomal dominant polycystic kidney disease

inherited disease that results in the development of renal, liver, and pancreatic cysts later in life; aka adult polycystic disease

duct of wirsung

main pancreatic duct

2

main pancreatic duct may be seen and should not exceed _____ mm in size

body and tail

mucinous cystadenocarcinomas are most often located

mucinous cystadenoma or cystadenocarcinoma

multilocular cystic masses that may contain mural nodules and calcifications that may be associated with dilatation of the pancreatic duct

lesser sac

one of the most common locations for a pancreatic pseudocyst is within the

duodenum

pancreas is located within the epigastrium between the C-loop and _________ and the splenic hilum

glucagon

promotes the release of glucose by the liver, which in turn increases blood sugar levels

Chronic pancreatitis

repeated bouts of pancreatic inflammation; recurring destruction of the pancreatic tissue resulting in atrophy, fibrosis, scarring, and calcifications within the gland

delta cells

restrains insulin and glucose levels

1. may appear normal 2. diffusely enlarged, hypoechoic pancreas 3. focal hypo echoic area within the pancreas 4. un-encapsulated anechoic fluid collection surrounding all or part of pancreas 5. pancreatic pseudocyst 6. abscess formation with gas bubbles 7. biliary obstruction 8. vascular complications (i.e thrombosis of SV) or (pseudo of SA)

sonographic appearance of acute pancreatitis:

1. well-defined 2. anechoic mass with posterior enhancement

sonographic appearance of true pancreatic cyst

1. hypoechoic mass that may contain calcifications 2. visualization is hard because of small size

sonographic finding of islet cell tumors:

1. hypechoic mass in the head of the pancreas 2. dilated CBD and pancreatic duct (double duct sign) 3. liver and other abdominal organs should be evaluated for metastasis 4. enlarged GB

sonographic findings of pancreatic adenocarcinoma:

beta cells

stimulates the body to use up glucagon to produce energy

insulin

stimulates the body to use up glucagon to produce energy

duct of santorini

the accessory duct to the duct of wirsung, it has its own attachment point to the duodenum

GDA

the arterial blood supply to the pancreas is via the

splenic artery and SMA

the body and trial receive blood supply from

d. adenocarcinoma

the most common form of malignancy of the pancreas is: a. cystadenocarcinoma b. islet cell tumor c. cystadenoma d. adenocarcinoma

pancreatic adenocarcinoma

the most common primary pancreatic malignancy usually found in the head

sphincter of Oddi

the muscle that controls the emptying of bile and pancreatic juices into the duodenum; aka hepatopancreatic sphincter

2-3cm

the pancreas head and body should measure

retroperitoneal

the pancreas is intraperitoneal or retroperitoneal?

false, can be functional or non-functional

true or false. islet cell tumors can only be functional.

insulinoma and gastrinoma.

two types of islet cell tumors

SMV, IMV, splenic vein, and portal veins

venous drainage is via

digest proteins

what do trypsin, chymotrypsin, and carboxypolypeptides do?

digests carbs

what does amylase do?

digests fats

what does lipase do?

neutralize stomach acids

what does sodium bicarbonate do?

a. duct of santorini

what is an additional name for the accessory duct of the pancreas? a. duct of santorini b. duct of langerhans c. duct of oddi d. duct of wirsung

pancreatic body

what is located anterior to the SMV, splenic vein, and SMA?

pancreatic neck

what is located anterior to the portal confluence?

uncinate process

what is located posterior to SMV, anterior to aorta, and may surround the SMV

pancreatic head

what is located right/lateral to the SMV, anterior to IVC, and inferior to the PV

acinar cells

what part of the pancreas carries out the exocrine process?

lipase

which laboratory value appears to be more specific for acute pancreatitis?

insulinoma

which type of islet cell tumor is more common